The core of the clinical picture of schizophrenia can be characterized as the splitting of one’s own “I”, the splitting of the personality. Most often, for a patient with schizophrenia, the world around him has no boundaries, the boundaries between the personality and the world are blurred. A person can no longer say with certainty who he actually is (“I have changed,” “I am controlled,” “there is someone else or two people in me at the same time”).
The patient gets the impression that thoughts and feelings are being taken away from him , leaving only emptiness and cold. Emptiness without boundaries, falling into the abyss, this is how patients most often talk about their condition. The state is incomprehensible and the patient gets the impression that someone is to blame for this, that he is being threatened, other persons or supernatural forces control his behavior, a feeling of helplessness arises. When a patient with schizophrenia expresses such judgments, it can be concluded that there is a violation of the integrity of the “I”. Violation of contact is also manifested by the impossibility of a full exchange of information with the outside world.
Perception is impaired. Things that are not related to each other are perceived as related to each other or to the patient himself, although in reality this is not. It is often difficult to separate essential facts from accidental events. For example, the patient considers certain noises, pictures, signs, paints to be extremely important.Some components of the surrounding world – faces, plants, streets, acquire a special symbolic meaning, being interpreted by the patient in terms of referring to himself, signs of threat. A person with schizophrenia believes that they are paying attention to others.
Sometimes people describe that everything, the surrounding world and other people, time and air are perceived as alien, changed, distorted, schematized. At the same time or independently of this, people have the impression that their own body has become alien, certain parts of the body have become larger or smaller, closer or further, body movements have become different, the face has become mask-like.
As noted above, impaired thinking is manifested by the impossibility of separating the important and the nonessential. Thinking seems to the observer to be incoherent and illogical; thought breaks, stops, meaningless slippage from one topic to another often occur . A person can not sometimes decide which thoughts he wants to express first, hence the pretentious thinking moves. This uncertainty may apply to a single word. Words can be used in a certain two-valued sense, i.e. two meanings can be embedded in one word, verbal neoformations (neologisms) appear.
In painting, there is an agglutination of images, reminiscent of the paintings of I. Bosch. This is the so-called. formal disorders of thinking. Delusional ideas of influence and representations belong to meaningful disorders of thinking . Some components of delusion often correspond to common ideas about the characteristics of the family or their own children’s world. With the help of delusional constructions, protection is often carried out against the demands of the outside world, as well as one’s own aggressive or erotic tendencies. Delirium can simultaneously be seen as a defense, from an internal seemingly insoluble conflict, and as an expression of often hidden, deep human needs. Delirium serves to regulate and direct human behavior. Certain actions can be understood from delirium. The subordination of behavior to delusional notions is easy to imagine if you remember how strongly ideas in which you are convinced influence behavior . If delusional begins to be questioned, intense anxiety arises, making delusional conviction unavailable for reasonable correction. Those around who often express doubts about the reality of delusions are woven into delusions as enemies, which once again shows the protective function of delusions. Hallucinations often support the subjective reality of delusions. The most common forms of manifestation are delusions of persecution, influence and attitude. Feelings are flattened, and often damaged not only the intensity of expression, but it and the whole world of the senses seems depleted. It looks emasculated, cold, glassy – “wood and glass”. Sometimes the expression of feelings, gestures and facial expressions is not consistent with the content of the statements, or with the situation. In some cases, very intense emotions arise that do not correspond to the real situation.
Relationships with other people in patients with schizophrenia are distorted or sharply narrowed. In an extreme form, withdrawal from the world, from contacts, manifests itself in autism. The latter is reflected in the behavior of the patient. The simultaneity of desire and lack of desire (ambivalence) often leads to inability to act (stupor), splitting in attitudes to ruptures.
In situations in which patients feel a threat to themselves, excitement, tension, fear prevail, which are realized in behavior. Close relatives often do not understand this, not seeing the subjective reasons for the threat, which, in turn, frightens them.
For most people who have suffered from schizophrenia for years and decades , they exhibit peculiar behavior, the latter fuses into a biographical unity with everyday activities and adapts to it. People with schizophrenia can for the most part live outside hospitals, often in their own home, but must lead a certain, sparing lifestyle.